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đ„ SLGT-2 Inhibitor-Induced Euglycemic Diabetic Ketoacidosis (EuDKA) - #MEDSHED
đ Sodium-glucose transporter type 2 (SGLT-2) inhibitors are FDA-approved for type 2 diabetes mellitus (T2DM)
đ Mechanism: Inhibition of SGLT-2 results in reduced glucose reabsorption in the proximal renal tubules
đ SGLT-2 inhibitors have seen increased prescribing from trials having positive outcomes in renal, cardiovascular, and all-cause mortality
đ Diabetic ketoacidosis manifests from counterregulatory hormones during acute stress responses in the setting of insulin deficiency
đ SGLT-2 inhibiters promote glucosuria (excessive glucose in urine) leading to ânormalâ serum glucose
đ Counterregulatory hormones break down free fatty acids combined with SGLT-2 inhibitor glucosuria results in euglycemic diabetic ketoacidosis (EuDKA)
đ„ Fluid Resuscitation
Crystalloid fluids 1 - 1.5 L within 1st hour
Subsequent fluid selection based on hydration, serum electrolytes, & urinary output
đ€ Insulin Therapy
0.1 unit/kg/hr IV infusion, questionable benefit of IV bolus
Transition with AMS resolution, anion gap closure, PO intake, optimized subq insulin regimen
đ Electrolytes
Hypokalemia and hypoglycemia are most common (consider potassium-containing fluids)
If BG < 250 mg/dL & anion gap remain elevated, start dextrose-containing fluids for insulin to continue running
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